Nomination Form - 2022 IEPA Elections

  • Please complete the following details by October 5th, 2022
    This form must be completed and signed by two nominators as well as the candidate.

    For any Vice President Roles the candidate must be primarily resident and have their main employment in the region covered by the Vice Presidency for which the candidate seeks election.

    The IEPA board recognises that early intervention in mental health networks are less developed in some regions. Therefore, if you wish to stand for election, but you do not know two nominators, existing IEPA board members can fulfil this function.

    Please contact the IEPA office via email to election2022@iepa.org.au if you require this kind of support to nominate.
  • Please provide your IEPA membership number. If you can't remember your member number you can look up you membership number here: https://bit.ly/3iEg7mD
  • Please indicate the position/s you wish to be nominated for. You may select multiple positions.
  • Please provide a 250 word biography that we can display on our promotional materials for the election
  • Please provide a 250 word Candidate Statement explaining why you would like to be part of the IEPA Board
  • If you are nominating for multiple positions and would like to provide an alternative Candidate Statement (optional), please provide your 2nd Candidate Statement explaining why you would like to be part of the IEPA Board. Please also state which role the 2nd candidate statement is for.
    Please note: The same candidate statement can be used for multiple positions.
  • Please provide a high quality headshot in .jpg file format that we can use for the elections.
    Drop files here or
    Accepted file types: jpg, Max. file size: 128 MB, Max. files: 2.
    • Please provide your signature in .jpg or .png file format
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      Accepted file types: jpg, png, Max. file size: 64 MB.
      • Please provide the IEPA membership number for each Nominator. If not known you can share this link with your nominator to help locate it: https://bit.ly/3iEg7mD
      • Please provide signature for Nominator 1 in .jpg or .png file format
        Drop files here or
        Accepted file types: jpg, png, Max. file size: 128 MB, Max. files: 3.
        • Please provide the IEPA membership number for each Nominator. If not known you can share this link with your nominator to help locate it: https://bit.ly/3iEg7mD
        • Please provide signature for Nominator 2 in .jpg or .png file format
          Drop files here or
          Accepted file types: jpg, png, Max. file size: 128 MB, Max. files: 3.
          • This field is for validation purposes and should be left unchanged.